Deniz Seçkin

Acquired perforating dermatosis: clinicopathological features in twenty‐two cases

Background  The term of acquired perforating dermatosis (APD) comprises the perforating dermatoses occurring in adult patients. Clinical and histological features of the disease are not uniform, and may resemble any of the four classic perforating disorders: elastosis perforans serpiginosa, reactive perforating collagenosis, perforating folliculitis or Kyrles disease. Chronic renal failure and/or diabetes mellitus usually accompany this skin disease.

Superficial fungal infections in 102 renal transplant recipients: a case-control study

BACKGROUND Renal transplant recipients are predisposed to superficial fungal infections caused by graft-preserving immunosuppressive therapy. Reports have documented a wide range of prevalence rates for superficial fungal infections in this patient group. OBJECTIVE The aim of this study was to determine the prevalence and clinical and mycological features of superficial fungal infections in renal transplant recipients at our center. METHODS One hundred two consecutively registered renal transplant recipients (34 women, 68 men) and 88 healthy age- and sex-matched persons acting as controls (30 women, 58 men) underwent screening for the presence of superficial fungal infection. Skin scrapings and swabs were obtained from the dorsum of the tongue, upper part of the back, toe webs, and any suspicious lesions. Nail clippings were also collected. All samples were examined by direct microscopy and were stained with calcofluor white. The samples were cultured in Sabouraud dextrose agar, mycobiotic agar, and dermatophyte test medium. Candida species were identified on the basis of germ-tube production, spore formation in cornmeal agar, and results of biochemical testing. Dermatophytes were identified on the basis of colonial and microscopic morphologic features in conjunction with results of physiologic evaluation (in vitro hair perforation test, urease activity, temperature tolerance test, and nutritional test). RESULTS Sixty-five (63.7%) of the 102 renal transplant recipients had cutaneous-oral candidiasis, dermatophytosis, or pityriasis versicolor, whereas only 27 (30.7%) of controls had fungal infection. Pityriasis versicolor was the most common fungal infection in the patient group (36.3%), followed by cutaneous-oral candidiasis (25.5%), onychomycosis (12.7%), and fungal toe-web infection (11.8%). Pityriasis versicolor and oral candidiasis were significantly more common among the renal transplant recipients, whereas the frequency of dermatophytosis in patients and controls was similar. Candida albicans was the main agent responsible for oral candidiasis, and Trichophyton rubrum was the most common dermatophyte isolated. Analysis showed that age, sex, and duration of immunosuppression did not significantly affect the prevalence of superficial fungal infection. Cyclosporine treatment and azathioprine therapy were identified as independent risk factors for superficial fungal disease. CONCLUSIONS The prevalence of opportunistic infections with Pityrosporum ovale and C albicans is increased among renal transplant recipients, probably owing to the immunosuppressed state of this patient population. However, renal transplant recipients are not at increased risk of dermatophytosis.

Concomitant vitiligo and psoriasis in a patient treated with interferon alfa-2a for chronic hepatitis B infection.

Abstract:  Well‐known cutaneous side effects of interferon (IFN)‐alfa therapy include dry skin, pruritus, hair loss, and psoriasis. Presumably because of its potent immunomodulatory activity, the use of IFN‐alfa has also led to the development of autoimmune diseases in susceptible individuals. Vitiligo, an autoimmune cutaneous disease, has been reported to occur during IFN‐alfa therapy. We report a 10‐year‐old girl with chronic hepatitis B infection in whom IFN‐alfa treatment induced de novo development of vitiligo and psoriasis. Neither skin condition improved after withdrawal of interferon treatment. Concomitant occurrence of vitiligo and psoriasis due to IFN‐alfa has not been reported previously.

The value of Tzanck smear test in diagnosis of erosive, vesicular, bullous, and pustular skin lesions

BACKGROUND Tzanck smear is generally used for the diagnosis of the pemphigus group of autoimmune bullous diseases and mucocutaneous herpesvirus infections. There are only a few studies in the literature investigating its diagnostic value. OBJECTIVES We aimed to investigate Tzanck smear findings and to determine the diagnostic value of this test in moist (erosive, vesicular, bullous, and pustular) skin lesions. We also aimed to develop an algorithmic approach for the diagnosis of these types of skin lesions according to the Tzanck smear findings. METHODS Samples were stained with May-Grünwald-Giemsa and evaluated by the same dermatologist. In some patients, methylene blue and Gram staining or direct immunofluorescence examinations were additionally performed. In all of the study cases, after the evaluation of clinical and laboratory findings (including, when appropriate, potassium hydroxide examination; viral serology; bacterial and fungal cultures; histopathology; direct and indirect immunofluorescence; patch testing), the definite diagnosis was established. We also determined the sensitivity and the specificity of certain Tzanck smear findings. RESULTS Tzanck smear was performed in a total of 400 patients with moist skin lesions. The sensitivities of multinucleated giant cells and acantholytic cells in herpetic infections, dyskeratotic acantholytic cells and cocci in bullous impetigo, pseudohyphae in candidiasis, acantholytic cells in pemphigus and more than 10 tadpole cells (magnification x100) in spongiotic dermatitis were 84.7%, 92%, 100%, 100%, and 81.5%, respectively. LIMITATIONS Because Tzanck smears were evaluated by the same dermatologist, no comment could be made regarding the interobserver reliability of this test and how the level of experience with this technique might affect the results. Also, the sensitivity and the specificity of Tzanck smear test findings for certain diseases could not be calculated because of an insufficient number of patients. CONCLUSION The Tzanck smear test is an inexpensive, useful, and an easy diagnostic tool for certain skin diseases.

Are lipoprotein profile and lipoprotein (a) levels altered in men with psoriasis

BACKGROUND Previous studies have demonstrated that patients with psoriasis may have an increased risk of a variety of noncutaneous diseases, including arterial and venous occlusive diseases. Changes in plasma lipid and lipoprotein composition in patients with psoriasis may be the reason for the increased risk of atherosclerosis in these patients. Lipoprotein (a) (Lp(a)) is a genetically determined lipoprotein associated with an increased prevalence of atherosclerotic and thrombotic cardiovascular diseases. OBJECTIVE The aim of this prospective study was to determine the lipid profile and to define the significance of Lp(a) levels in men with psoriasis. The other purpose was to learn whether a correlation exists between psoriasis area and severity index score and serum Lp(a) or other lipids. METHODS Serum Lp(a) levels were measured with a commercially available noncompetitive enzyme-linked immunosorbent assay in 32 men with psoriasis and in 13 healthy men. Total serum cholesterol, triglyceride, high-density lipoprotein, low-density lipoprotein, apolipoprotein A-I and apolipoprotein B levels, and atherosclerotic risk factors other than hyperlipidemia were determined. Secondary hyperlipidemia from various diseases and drugs was ruled out in both groups. RESULTS Serum Lp(a) levels were higher in men with psoriasis than in healthy male subjects, but the difference was not significant (p = 0.063). Serum fasting glucose levels were also found to be higher in the psoriasis group (p < 0.05). Higher serum Lp(a) and fasting glucose levels tended to occur in patients with extensive and severe skin involvement. No statistical differences were observed in the total cholesterol, triglyceride, high-density lipoprotein, low-density lipoprotein, apolipoprotein A-I, and apolipoprotein B levels between the two groups (p > 0.05). CONCLUSION Our results suggest that the increased Lp(a) level might be a factor involved in occlusive vascular disorders in patients with psoriasis and that patients with extensive and severe skin involvement are more predisposed to relatively high Lp(a) levels.

In vitro antifungal susceptibility patterns of dermatophyte strains causing tinea unguium.

Background.  Dermatophytes are the major responsible organisms in onychomycosis. Although recent antifungal agents have high success rates in treating this condition, lack of clinical response may occur in 20%. Antifungal drug resistance may be one of the causes of treatment failure. The need for in vitro antifungal drug resistance in daily practice is still under discussion.

Familial aquagenic acrokeratoderma: case reports and review of the literature

In recent years, a number of authors have described the development of palmar or palmoplantar keratoderma after brief exposure to water. Herein, we report a father and son with this condition, which we prefer to call aquagenic acrokeratoderma. These cases are interesting because they mark the first documentation of this entity in males. Also, they provide further evidence of familial occurrence.

Cutaneous sinus tract of dental origin

A 47‐year‐old woman presented with a nodular lesion on her face that had been discharging pus intermittently for 7 months. She could not recall any previous trauma to the site. Dermatologic examination revealed a nontender, erythematous, nodular, draining lesion on the patients chin ( Fig. 1 ). Dental examination showed poor oral hygiene and severe chronic periodontitis, but no acute infection. Radiography demonstrated diffuse periapical radiolucency associated with the right central mandibular incisor ( Fig. 2 ). The patient was diagnosed with chronic apical periodontitis. Because it was too late for her oral condition to be corrected with endodontic treatment, the tooth was extracted and the scar on her chin was revised later.

More experiences with the Tzanck smear test: cytologic findings in cutaneous granulomatous disorders.

BACKGROUND Granulomatous dermatitis is a distinctive histopathologic cutaneous reaction pattern against various infectious and noninfectious agents. Cytologically, granulomatous dermatitis shows granulomas and multinucleated giant cells. Various etiologic agents of granulomatous diseases can also be identified. OBJECTIVE We aimed to investigate Tzanck smear findings in granulomatous skin diseases. METHODS Patients who had granulomas and/or multinucleated giant cells of Langhans, foreign body- and/or Touton type in Tzanck smear tests were included in the study. In these patients, Tzanck preparations were then further evaluated for additional cytologic findings. Samples stained with May-Grünwald-Giemsa stain were evaluated by the same dermatologist throughout the study. In some patients, methylene blue, Gram and/or Erlich-Ziehl-Nielsen stains were also performed. In all of the study cases, the final diagnosis was established after the evaluation of clinical and laboratory findings (including, when appropriate, potassium hydroxide examination; bacterial, leishmanial, and fungal cultures; histopathology; tuberculosis and leishmania polymerase chain reaction). We also calculated the sensitivity and specificity of the Leishman-Donovan body for cutaneous leishmaniasis. RESULTS Over a 2-year period, 94 of 950 patients (9.9%) in whom Tzanck smear tests were performed had cytologic findings consistent with a granulomatous reaction. In 74 (78.7%) and 20 (21.3%) patients, the granulomatous reaction was due to infectious and noninfectious causes, respectively. Infectious causes included cutaneous leishmaniasis in 65 patients (87.8%), candidal granuloma in two patients, botyromycosis in two patients, and aspergillosis, blastomycosis, mucormycosis, leprosy, and cutaneous tuberculosis in one patient each. In 58 of 74 patients (78.4%) with infectious granulomatous dermatitis, the causes of the granulomas were identified. Noninfectious granulomatous reactions were due to granuloma annulare in 7 patients, sarcoidosis in 5 patients, a foreign body in 4 patients, necrobiosis lipoidica in 2 patients, and juvenile xanthogranuloma in 2 patients. In 17 of 20 patients (85%) with noninfectious granulomatous reactions, the cytologic findings were characteristic of the final diagnoses. The sensitivity and specificity of Leishman-Donovan bodies for cutaneous leishmaniasis were 76.9% and 100%, respectively. LIMITATIONS All of the samples were evaluated by the same dermatologist throughout the study; therefore no comment could be made regarding the reliability of the Tzanck smear test. In addition, the sensitivity and specificity of Tzanck smear test findings for diseases other than cutaneous leishmaniasis could not be calculated because of an insufficient number of patients. CONCLUSION The Tzanck smear test may be a useful diagnostic tool for certain granulomatous skin diseases.

Liver transplant recipient with concomitant cutaneous and visceral leishmaniasis

Abstract:  Diagnosis of leishmaniasis in immunosuppressed patients may be a serious challenge for physicians because of the major clinical and laboratory differences with immunocompetent patients. In immunosuppressed patients, the disease is characterized usually by disseminated visceral involvement, atypical cutaneous lesions and persistent negativity of diagnostic tests. Here, we report an eight‐yr‐old liver transplant recipient with concomitant cutaneous and visceral leishmaniasis in whom the cutaneous lesion led to the diagnosis of systemic involvement.